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First Name:Last Name:Email:Daytime Phone:Street Address:City:State:Zip:Date of Birth (Must be 21 or older):Do you currently hold a valid U.S. driver's license?
Yes
No
Do you currently have a Class-A CDL license?
Yes
No
Do you need a refresher course from a trucking school?
Yes
No
Have you had any at-fault accidents in the last year?
Yes
No
Have you had any drug or alcohol related driving offenses in the last 5 years?
Yes
No
Have you been convicted of a misdemeanor in the last 5 years?
Yes
No
Have you been convicted of a felony in the last 10 years?
Yes
No
Are you currently on probation or parole?
Yes
No
Are you epileptic or insulin dependent?
Yes
No
Do you have military experience? (If Yes, tell us about it in the comments section.)
Yes
No
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